GENERAL SURGERY STUDY GUIDE MBBS YEAR V 2020-2021
Transcript of GENERAL SURGERY STUDY GUIDE MBBS YEAR V 2020-2021
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GENERAL SURGERY
STUDY GUIDE
MBBS
2020-2021
BAQAI MEDICAL COLLEGE
BAQAI MEDICAL UNIVERSITY
51-Deh Tor, Gadap Road, Super Highway. P.O Box: 2407, Karachi-75340, Pakistan.
(092-21)34410-293 to 298, 34410-427 to 430
Fax: (092-21)34410-317, 34410-431
Email: [email protected], Web: www.baqai.edu.pk
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Contents
VISION & MISSION .......................................................................................................... 3
Baqai Medical University Vision Statement: ...................................................................... 3
Baqai Medical University Mission Statement: .................................................................... 3
Baqai Medical College Vision Statement: .......................................................................... 3
Baqai Medical College Mission Statement: ........................................................................ 3
OUTCOMES OF THE MBBS PROGRAM .................................................................................. 4
POLICIES AND PROCEDURES ............................................................................................. 5
SURGERY DEPARTMENT MISSION ...................................................................................... 7
FACULTY MEMBERS LIST ................................................................................................... 9
CURRICULUM OUTCOMES OF THE COURSE: ...................................................................... 11
Cognitive: .................................................................................................................. 12
Psychomotor: ............................................................................................................. 13
TEACHING METHODOLOGIES .......................................................................................... 15
General helpful hints ................................................................................................... 18
LECTURE SCHEDULE……………………………………………………………………………………………………………………….20
WARD SCHEDULE…………………………………………………………………………………………………………………………..21
LEARNING OBJECTIVES: ................................................................................................. 22
FINAL YEAR MBBS: ..................................................................................................... 22
FOURTH YEAR MBBS ................................................................................................... 23
THIRD YEAR MBBS ...................................................................................................... 24
LEARNING OBJECTIVES OF LECTURES .............................................................................. 25
LEARNING OBJECTIVES OF CBL…………………………………………………………………………………………………...36
TEACHING SCHEDULE OF MBBS STUDENTS………………………………………………………………………………..50
THIRD YEAR MBBS……………………………………………………………………………………………………………………..…50
FOURTH YEAR MBBS……………………………………………………………………………………………………………………..51
FINAL YEAR MBBS…………………………………………………………………………………………………………………………52
EXPECTATIONS FROM STUDENTS………………………………………………………………………………………………...53
ASSESSMENT METHODOLOGIES…………………………………………………………………………………………………..62
DISTRIBUTION OF TOPICS…………………………………………………………………………………………………………….63
ASSESSMENT CRITERIA…………………………………………………………………………………………………………………65
FEEDBACK TO THE STUDENTS………………………………………………………………………………………………………66
READING MATERIAL……………………………………………………………………………………………………………………….74
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VISION & MISSION
Baqai Medical University Vision Statement:
Baqai Medical University is a community based and community oriented, center
of excellence striving to mold students to become competent and caring health
professionals, groomed to be social leaders capable of improving health,
education and socioeconomic well-being locally, nationally and globally.
Baqai Medical University Mission Statement:
The mission of Baqai Medical University is to be recognized as a center of
excellence in education, research, patient care and community services by
producing highly capable and knowledgeable professionals.
Baqai Medical College Vision Statement:
Our vision is to enhance the access and excellence in medical education and
research, with the aim of capacity building of students and faculty through
innovations, and science and technology competencies, to achieve rapid and
sustainable health. The medical graduate thus produced will be informed and
trained enough to serve the community better, and to be advisor to the national
and international health organizations.
Baqai Medical College Mission Statement:
The mission of the Baqai medical college is to produce medical graduates, who
are accomplished individuals and have skills for problem solving, clinical
judgment, research & leadership for medical practice at the international level
and are also aware of the health problems of the less privileged rural and urban
population of Pakistan.
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Outcomes of the MBBS Program
By the end of five years MBBS program, The Baqai Medical College
graduate will be able to:
• Write and report focused history, perform physical examination, formulate a diagnosis and management plan for common health
problems. • Utilize knowledge of basic and clinical sciences for patient care.
• Apply evidence-based practices for protecting, maintaining and promoting the health of individuals, families and community.
• Identify problems, critically review literature, conduct research and disseminate knowledge
• Lead other team members as per situational needs for quality health service.
• Acquire professional behaviors that embodies lifelong learning, altruism, empathy and cultural sensitivity in provision of health care
service.
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POLICIES AND PROCEDURES
Code of Conduct and Maintenance of Discipline of Students Regulations
Under section 25(e) BMU Act.1996
All University students shall be under the full disciplinary control of the University.
No students shall be allowed to participate in politics. The action against the act
of indiscipline shall include fines, debarring from attending class and cancellation
of admission, depending on the gravity of indiscipline.
The following shall constitute acts of indiscipline for which action may be taken
against the student or students:
(a) Breach of any rule of public morals, such as:
• Use of indecent or filthy language;
• Use of immodest dress:
• Use of undesirable remarks or gestures; and
• Disorderly behavior, such as shouting, abusing, quarrelling,
fighting and insolence.
(b) Defiance of authority
(c) Action, defamatory of and derogatory to Islam
(d) Immorality
(e) Being found under the effect of an intoxicant or misuse of drugs
including marijuana, LSD dope and other opioids.
(f) False personation or giving false information or willful suppression of
information, cheating or deceiving.
(g) Inciting or staging a walk-out, a strike or an unauthorized procession.
(h) Shouting of slogans derogatory to the prestige of the University or
the reputation of its officers or teachers.
(i) Visiting without a pass places which are not to be visited without a pass.
(j) Visiting places declared out of bounds for students
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Every student must carry his / her Identity Card which will be open to examination
and will be demanded at the time of entrance to the various University Faculties
and functions.
No student will be admitted to the facilities of the library, transport or the canteen
unless he /she is in possession of the Identity Card.
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SURGERY DEPARTMENT MISSION
The mission of department of surgery is to provide the highest possible quality
care for the patient through innovative clinical services and advanced surgery,
state of the art educational programs and quality research, and training the health
care professionals to be skilled surgical scientists.
1. Introduction:-
We welcome you to the first surgery clerkship and hope that your time here will
be enjoyable and productive. Over the next nine weeks you will be exposed to a
variety of patients with conditions that are commonly considered amenable to a
surgical therapeutic approach. As expected by the curriculum committee, our
approach to this course has been to provide the student with an exposure to
surgical diseases that has been faced by our community.
The purpose of this manual is to provide you with the expectations of the
clerkship/s and to offer you references that will assist you to succeed and to avoid
confusion. Please read the information carefully so that you completely
understand the learning objectives, the service structure, your responsibilities
and priorities, and the policies for student evaluation.
Student will acquire the attitudes, skills, and knowledge of surgery necessary to
function effectively as a physician upon graduation from the Baqai medical
university. The appropriate resources and interactions with faculty and house staff
will be provided but it is ultimately the students that are responsible for their own
learning. The clerkships are structured for students who are self-initiating and
highly motivated to seek out opportunities for learning.
A major element of the surgery clerkships is an emphasis on the development of
clinical problem-solving skills. Our faculty believes that developing a sound
approach to clinical decision-making is the most important skill to develop.
The student on the surgical clerkship is encouraged to develop not just as a
technician, but more importantly to build a solid cognitive knowledge base, and
critical thinking skills. This goal will require the student to participate in an
appropriate blend of clinical and self-educational activities throughout the
clerkship.
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We believe that the interaction between student and faculty is a critical
component of the clerkship experience.
Although interaction with surgical house staff is important, this interaction can
never replace the active exchange between students and faculty. Faculty provides
ongoing feedback to students, and they are role models exemplifying how
surgeons approach problems and interact with patients, families and other
professionals. The clerkship encourages all students to actively seek feedback
from the physicians with whom they work. This should be done on an ongoing,
daily basis. A formal session with supporting documentation is required at the end
of the course.
Finally, student should be aware about his activities, role, requirements and
achievements throughout this course. The log book is designed to ensure a
minimum level of standardized training and continuous informative evaluation.
This manual includes the following:
1- The main and specific objectives of the course.
2- Learning outcomes in domains of learning.
3- Description of cognitive skills to be developed.
4- Description of the interpersonal skills and capacity to carry responsibility to
be developed.
5- Logbook, which includes:
a) a list of the clinical competencies and practical skills.
b) a list of general manual skills, and the communication skills which are
commonly practiced in the course.
c) Standard forms for documenting the performance of required training
activities, as well as the evaluation of the teachers.
6- Time table of lectures, seminars, tutorials, BST, ER, clinical SL and or
activities.
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FACULTY MEMBERS LIST:
1/ Prof. Khalid Ahmed MBBS, FCPS
Chairman and head of the Surgery Department
Professor
General Surgery
PMDC NO: 10239-S
Email: [email protected]
2/Prof. Muhammad Saddique Arain MBBS, FRCS
Professor
General Surgery
PMDC NO: 6237-S
Email: [email protected]
3/ Prof. Muhammad Aslam Siddiqui MBBS, FRCS
Professor
Orthopedic Surgery
PMDC NO: 1215-S
Email: [email protected]
4/ Prof. Ghulam Mustafa Kaimkhani MBBS, FCPS PROFESSOR
Orthopedic Surgery
PMDC NO: 6101-S
E-mail: [email protected]
5/ Dr. Ahmed Ali MBBS, MS
Associate Professor
Orthopedic Surgery
PMDC NO: 8819-S
Email: [email protected]
6/ Dr. Syed Muhammad Iqbal MBBS, MS
Associate Professor
Orthopedic Surgery
PMDC NO: 8952-S
7/ Dr. Bashir Ahmed MBBS, FCPS
Associate Professor
Pediatric Surgery
PMDC NO: 12458-S
Email: [email protected]
8/ Dr. Muhammad Abid Owais MBBS, FCPS
Associate Professor
General Surgery
PMDC NO: 40933-S
Email: [email protected]
9/ Dr. Muhammad Danish Muneeb MBBS, FCPS
Associate Professor
General Surgery
PMDC NO: 52458-S
Email: [email protected]
10/ Dr. Sadaf Iqbal MBBS, MS
Assistant Professor
General Surgery
PMDC NO: 53778-S
Email: [email protected]
11/ Dr. Shafatullah MBBS, MS
Associate Professor
Plastic surgery
PMDC NO: 9112-S
Email: [email protected]
12/Dr. Sidra Abbas MBBS, FCPS
Assistant Professor
General Surgery
PMDC NO: 56952-S
Email: [email protected]
13/ Dr. Abdul Ghaffar MBBS, MCPS, FCPS
Assistant Professer
General Surgery
PMDC NO: 12283-S
Email: [email protected]
14/ Dr. Rabail Bashir MBBS, FSPS
Senior Registrar
General Surgery
PMDC NO: 62065-S
Email:[email protected]
15/Dr. Faizan Iqbal MBBS, FCPS
Assistant Professor
General Surgery
PMDC NO: 57527-S
Email: [email protected]
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CURRICULUM OUTCOMES OF THE COURSE:
Outcomes of Surgery Course:
1) Acquisition of sound knowledge of general principles in surgery.
2) Description of the symptoms and signs of surgical cases & their
radiological & laboratory investigations & general plan of treatment.
3) Development of problem solving approach to common surgical problems
and disorders.
4) Explanation of the pathogenesis of various surgical problems, diseases
and their presentations.
Competency:
By the end of surgery course, the student should:
1) Show responsible and compassionate behavior with the patient and
family, considering the cultural, social and economic background, and
in dealing with all levels of education and abilities.
2) Use the required communication skills for taking appropriate clinical
history and conducting clinical examination.
3) Appreciate the role of perfect understanding of basic science
(anatomy, physiology, pathology, etc.) And the pathophysiological
process relevant to surgical practice, in diagnosis and management of
common illness in patient and community.
4) Be acquainted with the epidemiological profile of the population and
society, their heritage, cultural, social, geographic and economic
characteristics, and relationship of all these to surgical disease
etiology and management.
5) Have the knowledge and skills necessary to identify the health
problems of a patient in emergency situations, common endemic or
epidemic diseases and disabilities, including health promotion,
disease prevention, treatment, rehabilitation and follow up.
6) Opt for the wise selection of the most appropriate and cost effective
investigations to reach the proper diagnosis, considering the patient
rights and abilities, and the available health system resources,
weighing the pros and cons of surgical intervention.
7) Interact effectively with the surgical and other health teams, and
appreciate the role of others.
8) Be able to work within and leading a team, in clinical practice and
continuous learning in a problem based style.
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Cognitive: Knowledge and skills to be acquired:
By the end of this course the students should be able to:
1) Reflect, through good attitudes, responsible and serious concern to the
patient’s problems and his family taking into consideration the moral and
cultural characteristics of the society.
2) Explain to the patient, honestly and in simple terms, the surgical concepts
of disease and surgical interventions, and show concern for their economic
and social abilities in management choice.
3) Comply with the hospital system regarding uniform attendance, team work
and ethical responsible behaviour.
4) Describe pattern of surgical disease, in various age groups, and recognise
urgent/emergency surgical problems and critical conditions presented to
him.
5) Take full medical history, with appropriate sequence and
comprehensiveness in surgical ward, write it in a clear presentable way for
others to read and understand.
6) Asked to examine a patient; prepare the appropriate setup for physical
examination, carry out the examination in appropriate manner, sequence
and comprehensiveness of all systems, relevant to surgical problems, write
his notes in a clear way for others.
7) Select the relevant investigations regarding the available resources and cost
effectiveness.
8) Integrate and interpret the results obtained from skills 5, 6 & 7 to reach
probable diagnosis or suggest differential diagnoses of the problem
presented.
9) Write an informative referral letter asking help on particular patient’s
problem.
10) Show ability and enthusiasm to promote health through health
education and provision of primary health programs.
11) Deal effectively and efficiently with patients at various age groups who
are presenting with chronic, malignant or emergency surgical problems.
12) Draw detailed plan of onsite management, transfer, resuscitation and
list criteria of observing and monitoring a critically ill patient.
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13) Describe causes, types and management protocols of burns, including
fluid therapy, pain relief, short and late consequences and their
management.
14) Prescribe fluid and electrolyte therapy, considering the acid-base
balance of the body.
15) Describe the components of blood, origin, count and functions of blood
cells, techniques and complications of blood transfusion.
16) Presented with any of the following real, verbal or written emergency
problems; perform or suggest urgent lifesaving procedures, diagnose,
manage or suggest steps of effective management of these conditions:
multiply injured patients, shock, bleeding patient, coma, chest pain, cardiac
arrest, convulsions, respiratory distress, acute abdominal pain, septicaemia,
intestinal obstruction, and diabetic ketoacidosis.
Psychomotor: By the end of this course the student should be able to:
1. Take a detailed history from a surgical patient, relatives and others.
2. Perform a complete physical examination of a surgical patient.
3. Present a summary of the assigned case to a faculty member during a ward
round.
Exposure to surgery is essential for all medical students for several reasons:
1. Surgical conditions are responsible for a significant proportion of elective
and emergency referrals. All graduating doctors require knowledge of
surgical principles and an understanding of the management of common
surgical conditions for the rest of their career. A minimum level of
competency is required to ensure good care for future patients seen within
any branch of medicine.
2. Surgical wards and clinics provide an excellent environment to develop
those clinical skills that are required of all medical students. They provide
training in general medical skills such as history taking, physical
examination, diagnostic formulation and management. They also provide
an environment that allows development of non-clinical skills such as
communication and team-working. There are often very rapid changes in a
patient’s condition, allowing for immediate reinforcement of learning and
reflection on interventions.
It is more important that undergraduates have an adequate exposure to surgery
during their training. The skills and knowledge gained are transferable to other
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interventional specialties and also are crucial to the care of patients provided by
general practitioners and those in other specialties.
The final outcomes in surgical rotations include the following:
• To recognize and understand common surgical conditions.
• To recognize and understand emergency surgical presentations.
• To be aware of what treatment possibilities are available, including non-
operative.
• To understand the principles of preoperative optimization.
• To understand postoperative complications.
• To understand the types and risks of anesthetic procedures.
• To be able to explain in general terms to a patient the implications of a
common surgical diseases.
• To have sufficient basic understanding of surgery to help with future career
choice.
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TEACHING METHODOLOGIES
Course Design:-
The training requirements are divided into 2 main categories which differ as regards
methods of training and evaluation:
1. Theoretical part: which include:
Lectures: The formal lecture schedule is delivered by faculty within their own discipline
and takes the form of didactic lectures. The subject matter of the lecture is circulated in
advance so the students can prepare it.
Tutorials & Seminars: Students are assigned to a ‘rotating tutorial’ group and receive
tutorials by different tutors within the area of surgery. A fixed topic is usually discussed
by the tutors and as such they function as an adjunct to the formal lecture schedule
delivered. Students are attached to surgical groups throughout the course and receive
regular tutorials from the members of these groups in addition to the above mentioned
tutorials, as detailed in the individual team timetables.
The Following Common / Major Presenting Problems:
• Hernias including Abdominal Wall Hernias
• Pancreatic Diseases
• Biliary Tract Diseases
• Breast And Adrenal Diseases
• Colorectal And Anal Conditions
• Common Ambulatory Skin and Soft Tissue Problems
• Diseases Of the Esophagus
• Fluids And Electrolytes Imbalance
• Intestinal Obstruction
• Liver Diseases
• Malignant Diseases of the Skin
• Shock
• Spleen Diseases
• Small Intestinal and Appendicular Conditions
• Stomach And Duodenal Conditions
• Surgical Bleeding and Blood Replacement
• Surgical Infections
• Thyroid And Parathyroid Diseases
• Trauma
• Wounds And Wound Healing
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2. Clinical Rotations:
This is where art of medicine is learned.
Students are assigned to all surgical teams for a period of 9 weeks whereby they attend
outpatient’s clinics, theatre, surgical day ward, ward rounds, case conferences and
interdisciplinary meetings.
In these attachments, students are exposed to a wide spectrum of surgical diseases. By
following patients through their initial presentation to the operating room and post-
operative care, they observe the evolution and resolution of surgical disease processes.
Teaching in the operating room and at the bedside in particular, the attachments provide
the students the opportunity to actively expand their knowledge, develop technical and
clinical skills and initiate relationships with patients, residents, faculty and staff. In these
nine weeks, students are exposed to surgery and shown what it means to be a surgeon
at all levels and see why surgery is such an exciting career.
You will be divided into small groups for this purpose to optimize your opportunities of
learning, it is expected that every student should participate in these sessions and your
teacher will facilitate that.
Clinical attachment: Refer to the sequential tasks of the clinical encounter; namely:
history taking, clinical examination, discussing the diagnosis, formulating the plan of
management, and follow-up.
Bedside teaching: Bedside sessions are designed to promote teaching and interaction
with faculty members. A variety of methods for presentation are utilized by varying
faculty members. Students will meet a faculty member on a designated ward and/or
conference room and will have the opportunity to interact in a small group setting with
fellow students and a faculty member.
Outpatient clinic: The student will be attending one clinic, taking history of pre & post
operative patient, observing how patient is being prepared. Each attending/service will
be having clinics at least one day each week. If you are assigned to a particular faculty
member, you should plan to be in clinic with that attending faculty member. If you are
not assigned to a particular faculty member, then the chief of the service will direct you
as to which clinic you should attend. Clinic is a great opportunity to meet patients
preoperatively. It also provides a chance to follow patients through the entire process
from preoperative evaluation through to the post-operative visit.
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General Tips:
• Professional dress is required for all clinics. Sometimes you will be
unexpectedly needed in clinic, so it is important to bring appropriate attire
for clinic to work every day.
• Each attending has preferences. Ask the attending if they prefer you to
see patients on your own or with a consultant.
• When seeing new patient, perform a complete history and physical
examination. You will present to the attending.
• When seeing return patients perform a directed history and physical
examination. Limit your interview and exam to the relevant information.
• If you don’t know whether or not you should do something (i.e take down
a dressing), ask someone. Don’t just assume you should skip it or assume
you should do it.
• If the patient you see is going to be scheduled for the operating room,
ask a consultant how you can help with the preoperative paperwork.
• Try to be efficient. The clinics are often overbooked and you need to be
fast, but thorough.
Operating Theater: It is the stage in which practice integrated knowledge with skills, is
being observed. Be on time for each case. You should arrive with the patient or even
before. Cases typically start at 8:30 AM, but you are expected to show up after you finish
up your morning lectures. Try to meet the patient preoperatively in the pre-care; you
need to be diligent about checking on the room and the patient in the holding area.
General Tips:
• Introduce yourself to the operating room staff.
• Help to position the patient.
• Remove your mobile before scrubbing.
• You are a part of the team. Ask questions and be ready to participate. The
team is counting on you and will get you actively involved.
• Understand that there is a time for questions and a time to be silent. If
the situation seems tense or the team brushes you off, this may mean it
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is the wrong time for questions. Hold onto your questions, though, and
ask them later.
• Wear appropriate attire – scrubs, scrub hat, mask, eye protection, and
shoe cover.
• Always get your gloves out for the scrub nurse/tech. Ask if they need an
extra gown for you.
• This is a great time for procedures – learn to place a Foley, start an IV,
prep the patient, etc. Again simply being present may not be enough. If
there is something you would like to learn / how to do, ask.
• Be attentive during the case – how much you can help is directly related
to your being aware of what is going on.
• At the end of the case, you can help to get the patient transferred to the
recovery area– this includes getting the stretcher, helping move the
patient, and learning to write post-op orders and prescriptions.
Emergency department(ED): ED Learning objectives are practical procedure-based
scenarios, all of which can easily be accomplished in rotation. You will attend them for
one day per week. A greater diversity of problems will be seen outside usual business
hours. This can be quite hectic and appear disorganized. You must be motivated to
participate and not wait for someone to suggest a task. The more involved you are, the
easier it will be to complete the learning objectives. You should ask the nurse in charge
or a doctor about the patient’s suitability for a procedure or a history / examination.
General helpful hints • The more you show yourself to be interested; the more people will involve you. By
asking questions and asking for opportunities to participate, you show that you are
interested in learning. People respond positively to this and whether intentionally
or not, they will end up involving you more. If you don’t know where you are
supposed to be, ask someone. Your consultant is always around and can help give
instructions or suggestions about where you might learn the most.
• Ultimately, you are responsible for your learning. You are not given a detailed
syllabus for task like you were for lectures. This does not mean you don’t need to
read and study. It simply means you will need to do self-directed reading. Think
about what you do and don’t know well and read to fill in the gaps.
• Figure out what you need to know about surgery, ask yourself what you need to
know about pre-operative clearance of patients for surgery or management of post-
operative surgical complications.
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• Ask for feedback on your performance at least once during your rotation. This is
another great way to show you are interested in learning. Don’t accept “don’t worry
about it, you’re doing fine” as an answer. There are things that even the best
clinicians can do to take their learning to the next level. Be prepared, though, when
you ask for feedback, you may get some negative feedback. This is not intended
to hurt you or put you down. This is intended to be constructive and to help you
find ways to improve as a clinician and as a team member.
• Respect the non-physician staff. The truly successful medical student will quickly
learn that everyone involved in patient care can be a valuable resource for learning.
Often other staff will have more time for teaching than the physicians. In general,
you will find that if you ask, almost anyone will be happy to teach you.
• Lastly, and most importantly, have fun.
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*Learning Objectives Reference
LECTURE SCHEDULE AND TIMINGS ; TUESDAY
NO L.OBJ. REF.* TOPIC LECTURER
1 SURG-LEC-1 INTRODUCTION OF SURGERY PROF. KHALID AHMED
2 PLASTIC-LEC-1A BURNS MANAGEMENT DR. SHAFATULLAH
3 SURG-LEC-2 SHOCK & HAEMORRHAGE DR. BASHIR AHMED
4 SURG-LEC-3 PRE & POST OPERATIVE PREPARTION PROF. M. SADDIQUE
5 SURG-LEC-4 BLOOD TRANSFUSION DR. BASHIR AHMED
6 SURG-LEC-5 WOUND MANAGEMENT DR. BASHIR AHMED
7 PLASTIC-LEC-1B BURNS MANAGEMENT DR. SHAFATULLAH
8 PLASTIC-LEC-2 SKIN GRAFTING AND SKIN FLAPS DR. SHAFATULLAH
9 ANES-LEC-1 SPINAL & LOCAL ANAESTHESIA, PAIN MANAGEMENT DR. NAILA
10 SURG-LEC-6 TRAUMA MANAGEMENT DR. SIDRA ABBAS
11 SURG-LEC-7 HEAD INJURY DR. M. DANISH
12 ORTHO-LEC-1 PRINCIPLES OF FRACTURES
PROF. ASLAM
SIDDIQUE
13 SURG-LEC-8 OBSTRUCTIVE JAUNDICE DR. SIDRA ABBAS
14 SURG-LEC-9 SPLENOMEGALY DR. M. DANISH
15 SURG-LEC-10 INTESTINAL FISTULAE & STOMAS DR. M. ABID OWAIS
16 SURG-LEC-11 ACID - PEPTIC DISEASE DR. M. ABID OWAIS
17 SURG-LEC-12 ACUTE ABDOMEN DR. M. ABID OWAIS
18 SURG-LEC-13 PARATHYROID DISORDERS PROF. M. SADDIQUE
19 SURG-LEC-14 SALIVARY GLAND DISORDERS PROF. M. SADDIQUE
20 SURG-LEC-15 CHOLELITHIASIS & MINIMAL INVASIVE SURGERY PROF. M. SADDIQUE
21 SURG-LEC-16 ACUTE PANCREATITIS DR. SIDRA ABBAS
22 SURG-LEC-17 BENIGN BREAST DISEASES PROF. KHALID AHMED
23 SURG-LEC-18 CARCINOMA OF BREAST PROF. KHALID AHMED
24 SURG-LEC-19 GASTRIC CANCER/GASTRIC OUTLET OBSTRUCTION PROF. M. SADDIQUE
25 SURG-LEC-20 DYSPHAGIA DR. SIDRA ABBAS
26 SURG-LEC-21 BENIGN THYROID DISEASE PROF. KHALID AHMED
27 SURG-LEC-22 THYROID NEOPLASM PROF. KHALID AHMED
28 SURG-LEC-23 ACUTE APPENDICITIS PROF. KHALID AHMED
29 SURG-LEC-24 INTESTINAL OBSTRUCTION PROF. KHALID AHMED
30 SURG-LEC-25 COLORECTAL TUMORS PROF. M. SADDIQUE
31 SURG-LEC-26 DIFFERENTIAL DIAGNOSIS OF NECK SWELLING PROF. KHALID AHMED
32 SURG-LEC-27 ANORECTAL DISEASE PROF. M. SADDIQUE
33 SURG-LEC-28 ABDOMINAL WALL HERNIAS DR. M. ABID OWAIS
34 URO-LEC-1 URINARY TRACT INFECTION & RENAL CALCULI DR. IMRAN SHARIF
35 URO-LEC-2 BENIGN PROSTATIC HYPERPLASIA DR. IMRAN SHARIF
36 SURG-LEC-29 VARICOSE VEINS DR. M. ABID OWAIS
37 URO-LEC-3 SCROTAL SWELLINGS DR. IMRAN SHARIF
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TOPICS FOR DISCUSSION (CBD*)
CBD: Case Based Discussion(TUTORIAL)
1st
INGUINAL HERNIA
(CBD-1)
VENTRAL WALL
HERNIA
(CBD-1)
VARIOCOSE VEINS
(CBD-7)
2nd
ACUTE ABDOMEN
(CBD-3,4,9)
ACUTE APPENDICITIS
(CBD-3)
INTESTINAL
OBSTRUCTION
(CBD-9)
3rd
GALL BLADDER
DISEASES (CBD-2)
ACUTE
PANCREATITIS(CBD-
4)
OBSTRUCTIVE
JAUNDICE(CBD-5)
4th
THYROID SWELLINGS
(CBD-11)
NECK SWELLINGS
(CBD-11)
BREAST LUMP &
ASSOCIATED DISEASE
(CBD-6)
5th BENIGN TESTICULAR
SWELLINGS
NUTRITION IN
SURGICAL PATIENTS
TESTICULAR TUMORS
6th PERIANAL DESEASES
(CBD-13)
DYSPHAGIA(CBD-8)
COLORECTAL
DESEASES (CBD-10)
7th GASTRIC CANCER &
OUTLET
OBSTRUCTION
(CBD-12)
RENAL CALCULI
BENIGN PROSTATIC
HYPERPLASIA
8th TRAUMA
MANAGEMENT
PRE-OPERATIVE
WORKUP
POST-OPERATIVE
CARE
9th VASCULAR DISEASES RADIOGRAPHS
WARD TEST
22
LEARNING OBJECTIVES:
Final Year: BEDSIDE TEACHING:
At the end of the bedside session, the student will be able to:
• Record a pertinent history from the given patient so as to be able to reach
a working diagnosis
• Perform a thorough clinical examination of a surgical patient.
• Present a summary of the assigned case to a faculty member during a ward
round.
• Justify the correct steps of recording a history from a patient.
• Demonstrate the logical steps of examining a given patient
• Defend differential diagnosis of the given case.
• Prioritize the problem specific investigations needed for pre-operative
workup for the given patient.
• Formulate a management plan for the given patient.
OUT PATIENT DEPARTMENT:
During OPD posting, student should be able to:
• Take a brief history from the given patient
• Carry out the relevant examination of the given patient.
• Defend the working diagnosis after history and physical Examination of a
given patient.
• List the baseline investigations needed for pre-operative workup of the
patient.
• Recommend a comprehensive management plan for the given patient
including surgical procedures.
OPERATION THEATRE:
In operation theatre, the final year student should be able to
• Enlist the complete protocols for maintaining asepsis in theatre.
• Demonstrate basic principles of gloving and gowning.
• Describe the types of sterilization techniques and disinfection.
• Enlist the preoperative preparation and intraoperative care of the surgical
patient.
• Classify the types of anaesthesia used in different surgeries.
• Explain various intraoperative complications encountered during surgery.
23
FOURTH YEAR MBBS
WARD:
At the end of the bedside session, the student will be able to:
• Record a pertinent history from the given patient so as to be able to reach
a working diagnosis
• Perform a complete clinical examination of a surgical patient.
• Justify the correct steps of recording a history from a given patient.
• Demonstrate the logical steps of examining a given patient
• Defend differential diagnosis of the given case.
• Enlist the investigations needed for pre-operative workup of the given
patient.
OUT PATIENT DEPARTMENT:
During OPD posting, student should be able to:
• Take a detailed history from the given patient
• Carry out the relevant examination of the given patient.
• Defend the working diagnosis after taking a history and physical
Examination of a given patient
• List the baseline investigations needed for pre-operative workup of the
given patient.
OPERATION THEATRE:
In operation theatre, student should be able to:
• Enlist the complete protocols for maintaining asepsis in theatre.
• Explain basic principles of gloving and gowning.
• Enlist the preoperative preparation and intraoperative care of the surgical
patient.
• Classify the types of anaesthesia used in different surgeries.
24
THIRD YEAR MBBS
WARD:
At the end of the bedside session, the student will be able to:
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis
• Justify the correct steps of recording a history from a given patient.
• Perform a complete clinical examination of a surgical patient.
• Demonstrate the logical steps of examining a given patient
OUT PATIENT DEPARTMENT:
During OPD posting, student should be able to:
• Take a brief history from the given patient
• Carry out the relevant examination of the given patient.
OPERATION THEATRE:
In operation theatre, student should be able to
• Enlist the complete protocols for maintaining asepsis in theatre.
• Explain basic principles of gloving and gowning.
• Enlist the types of anaesthesia used in different surgeries.
25
LEARNING OBJECTIVES OF LECTURES
At the end of this 1 hour lecture, the final year MBBS student will be able to:
INTRODUCTION OF SURGERY: (SURG-LEC-1) • Define the principles of skin incisions.
• Discuss the concept of skin tension or Langer’s lines and their practical
application.
• Describe different types of abdominal incisions and the types of
surgeries where these are considered.
• Classify the characteristics and types of drains, their mode of action,
and classification as active and passive.
• Explain the use of diathermy, ligature and harmonic scalpel.
SHOCK AND HEMORRHAGE: (SURG-LEC-2) • Define the pathophysiology of shock.
• Label the cardiovascular and metabolic characteristics of shock.
• Classify the clinical features of shock.
• Define types of hemorrhage.
• Define the terms like damage control surgery and damage control
resuscitation
PRE AND POST OPERATIVE PREPARATIONS:
(SURG-LEC-3) • Describe the importance of WHO checklist and its components.
• Explain how to reduce intraoperative risks of positioning, venous
thromboembolism, infection, and hypothermia, by using appropriate
monitoring and equipment.
• Determine fluid and electrolyte managements in the pre and
postoperative patient
• Describe the nutritional requirements of surgical patients and
explain different method of providing nutritional support and its
complications
• Determine and treat postoperative complications
• Describe the concept of day surgery pathway and explain the
spectrum of surgical procedures suitable for day surgery.
BLOOD TRANSFUSION: (SURG-LEC-4)
26
• Classify blood products and define their characteristics.
• Define practical application of ABO and Rhesus blood system
• Describe the indications of blood transfusion.
• Explain different blood group system.
• Enlist complications of blood transfusion.
WOUND MANAGEMENT: (SURG-LEC-5) • Define the phases of wound healing and the factors influencing the
healing of a wound.
• Define the management of compartment syndrome.
• Describe the etiology and leg ulcers, and different aspects of their
management.
• Describe staging and characteristics of pressure sores.
• Define necrotizing skin infections, their etiology and management.
• Enumerate differences in hypertrophic and keloid scars.
BURNS MANAGEMENT: (PLASTIC-LEC-A & B)
• Define different types of burns and establish prevention and
immediate care of burn patient.
• Define the criteria for acute admission in burns unit.
• Describe the major determinants affecting the outcome in burns
patient.
• Explain the causes of burn and how to assess the area burnt.
• Predict the plan of fluid resuscitation thorough different formulae.
• Describe the nutritional management in burn patient.
• SKIN GRAFTING AND SKIN FLAPS: (PLASTIC-LEC-2)
• Define the anatomy of skin and the spectrum of plastic surgical
techniques used to restore bodily form and function.
• Define the relevant anatomy and physiology of tissues used in
reconstruction.
• Describe the concepts of various skin grafts and how to use them
appropriately.
• Explain principles and use of flaps.
• Discuss how to use plastic surgery to manage difficult and complex
tissue loss.
• TRAUMA MANAGEMENT: (SURG-LEC-6)
• Discuss how to assess and respond to a trauma problem.
• Develop the value of planning and describe the priorities in the
early assessment of the injured patient.
• Define the principles of triage in the immediate management of
injured patient
27
• Discuss the concepts of injury recognition and prediction based on
the mechanism and energy of injury.
• Describe the principles of primary and secondary surveys in the
assessment and management of trauma.
• Explain the techniques for the initial resuscitative and definitive
care aspects of trauma.
• HEAD INJURY: (SURG-LEC-7)
• Define the physiology of cerebral blood flow and the
pathophysiology of raised intracranial pressure.
• Describe how to take history in head injury patient and its
management.
• Establish the diagnosis and management of spontaneous
intracranial bleeding including sub arachnoid hemorrhage.
• Describe Glasgow Coma Scale and classify traumatic head injury.
• Discuss the ATLS protocols and its application in primary and
secondary survey.
• Interpret the discharge criteria in minor and mild head injury and
explain the NICE guidelines for CT scan in head injury.
• OBSTRUCTIVE JUANDICE (SURG-LEC-8)
• To summarize the basic anatomy and physiology of the biliary
system.
• Classify the various types of jaundice and their causes.
• To demonstrate the pathophysiology and complications of
obstructive jaundice
• Enlist the common causes of obstructive jaundice in a sequential
manner.
• Plan and justify required non-invasive & invasive investigations in
obstructive jaundice
• Outline a management plan for a patient suffering from obstructive
jaundice presenting to the emergency / OPD.
• Describe a management plan including surgical options for a
patient suffering from obstructive jaundice and its complications.
• SPLENOMEGALY: (SURG-LEC-9)
• Define the functions of spleen
• Describe the common pathologies involving the spleen
• Discuss the principles and potential complications of splenectomy
• Explain the potential advantages of laparoscopic splenectomy
• Interpret the benefits of splenic conservation
• Define the importance of prophylaxis against infection following
splenectomy
28
• INTESTINAL FISTULA AND STOMA: (SURG-LEC-10)
• Describe the anatomy and physiology of gastrointestinal tract
a) Define the pathologies and surgeries of intestinal tract which may
lead to stoma formation.
b) Discuss difference in anatomy and physiology of ileostomy and
colostomy
c) Discuss the definitions and pathophysiological basis of temporary
and permanent stomas
d) Define the concept of stoma bags
e) Discuss the counseling and required pre and post stoma care
ACID-PEPTIC DISEASE: (SURG-LEC-11)
a) Define the gross and microscopic anatomy and pathophysiology of
stomach along with the structures and organs related to upper
gastrointestinal tract like gallbladder and pancreas
b) Explain the differential diagnosis and interpret the investigations
related to the pathology of stomach and duodenum
c) Interpret the critical importance of gastritis and Helicobacter
pylori in the upper gastrointestinal disease
d) Identify and treat peptic ulcer disease and its complications
e) Describe the operations for duodenal ulcer and their indications
ACUTE ABDOMEN: (SURG-LEC-12)
a) Define the etiology and pathophysiology of common intestinal
conditions
b) Identify the importance of non-surgical management of intestinal
conditions
c) Describe the management of acute surgical problems of intestines
d) Explain the pathophysiology of dynamic and adynamic intestinal
obstruction
e) Define the cardinal features on history and examination
f) Identify the causes of small and large bowel obstruction
g) Describe the indications for surgery and other treatment options
in bowel obstruction.
PARATHYROID DISORDERS: (SURG-LEC-13)
a) Describe the development and anatomy of the parathyroid glands
b) Discuss the physiology and investigations of parathyroid function
c) Order appropriate investigations for parathyroid swellings
d) Enumerate the indications of surgery in parathyroid swelling
29
e) Describe the investigation and management of various types of
hyperparathyroidism.
f) Enlist the risks and complications of parathyroid surgery.
SALIVARY GLAND DISORDERS: (SURG-LEC-14)
a) Define the surgical anatomy of the salivary glands
b) Describe the presentation, pathology and investigation of salivary
glands
c) Explain the medical and surgical treatment of stones, infection,
and tumors that affect salivary glands
d) Classify salivary gland tumors
CHOLELITHIASIS AND MINIMAL INVASIVE SURGERY (SURG-LEC-15)
a) To summarize the basic anatomy and physiology of the gall bladder
and bile ducts.
b) To demonstrate the pathophysiology, management and complications
of gallstones
c) Enlist the disorders of the biliary tree
d) Classify the various types of gall stones and their causes.
e) Classify malignant disease of the gall bladder and bile ducts
f) Plan and justify required investigations including invasive
investigations in gall bladder diseases.
g) Describe a management plan including surgical options for a patient
with cholelithiasis and/or its complications.
h) To understand the basic concept of minimal invasive surgery including
laparoscopic cholecystectomy.
i) Enlist the advantages, limitations and possible complications of
laparoscopic surgery.
ACUTE PANCREATITIS (SURG-LEC-16)
a) Summarize the surgical anatomy and physiology of pancreas.
b) Enlist Congenital abnormalities of the pancreas
c) Enumerate the causes of acute pancreatitis.
d) Enlist the differential diagnosis of acute pancreatitis
30
e) Demonstrate various scoring systems of assessment of
pancreatitis
f) Enlist the investigation needed for suspected pancreatitis
g) Develop a management plan for a patient suffering from
acute pancreatitis.
BENIGN AND MALIGNANT BREAST DISEASES (SURG-LEC-17, 18)
a) To summarize the basic anatomy and physiology of the breast.
b) To demonstrate congenital anomalies of breast
c) Enlist the causes of breast lump
d) Classify breast lump and association with hormonal changes
e) Demonstrate triple assessment
f) Plan and justify required investigations for breast lump.
g) Enlist investigations needed for staging malignant breast lump
h) Propose a management plan for a patient who has been diagnosed as
a benign breast disease.
i) Devise a management strategy on the basis of current scientific
evidence for a patient diagnosed as having a malignant breast disease.
GASTRIC CANCER & GASTRIC OUTLET OBSTRUCTION (SURG-LEC-
19)
a) Summarize the gross and microscopic anatomy and pathophysiology
of the stomach in relation to disease
b) Enlist the causes of gastric outlet obstruction.
c) Decide on the most appropriate techniques to use in the investigation
of patients with gastric outlet obstruction
d) Describe the critical importance of gastritis and helicobacter pylori in
upper gastrointestinal disease
e) To be able to investigate and treat peptic ulcer disease and its
complications
31
f) To be able to recognize the presentation of gastric cancer and
understand the principals involved in its treatment
g) Summarize a management approach for a patient diagnosed as gastric
carcinoma.
DYSPHAGIA (SURG-LEC-20)
a) Summarize the basic anatomy and physiology of the esophagus and
their relationship to the disease
b) Enumerate congenital anomalies of esophagus
c) Enlist the causes of dysphagia
d) Classify dysphagia
e) Enlist the clinical features, investigations and treatment of benign and
malignant diseases of esophagus
f) Plan and justify required investigations for dysphagia
g) Devise a plan to manage a patient with carcinoma esophagus.
h) Formulate a management strategy, based on surgical principles, for
the management of a patient presenting with dysphagia.
i) Enumerate various types of esophagectomy according to the site of
malignant lesion.
j) Formulate a nutrition support plan for a patient undergoing an
esophagectomy with emphasis on both pre and post-operative stages.
NECK SWELLINGS AND THYROID DISORDERS (SURG-LEC-21,22,26)
a) Describe the development and anatomy of the thyroid glands
b) Summarize the physiology and investigation of thyroid disorders
c) Explain the lymphatic drainage of neck
d) Enlist the causes of neck swelling from the commonest to rarest
e) Classify various types of neck swelling
f) Select appropriate investigations for neck swellings
g) Devise a management plan including medical, surgical and nuclear
medicine options for a patient with goitre.
32
h) Describe how to treat thyrotoxicosis and thyroid failure
i) Justify when to operate on a thyroid swelling
j) Describe different types of thyroid surgeries
k) Enlist the risks and complications of thyroid surgery
ACUTE APPENDICITIS (SURG-LEC-23)
a) To summarize the aetiology and surgical anatomy of acute
appendicitis
b) Explain the basic concept of migratory right iliac fossa pain.
c) Enumerate the causes of right iliac fossa pain from the
commonest to rarest
d) Enlist the investigation needed for suspected appendicitis
e) Outline a management plan for a patient suffering from acute
appendicitis
• Explain various types of incisions for appendicectomy
• Enumerate Common conditions encountered preoperatively
• Describe the management of postoperative problems
• INTESTINAL OBSTRUCTION (SURG-LEC-24)
• To summarize the basic anatomy and physiology of small and large
intestines
• To describe the pathophysiology of intestinal obstruction
• To differentiate between dynamic and adynamic intestinal obstruction
• Enlist the causes of intestinal obstruction from the commonest to
rarest
• Classify various types of intestinal obstruction.
• Explain the possible complications of intestinal obstruction.
• Outline a strategy to manage a patient with intestinal obstruction.
• indications for surgery and other treatment options in bowel
obstruction
• Propose a nutrition plan which includes both enteral and parental
components for a patient who has undergone small bowel resection.
• COLORECTAL DISEASES (SURG-LEC-25)
• Summarize the anatomy of the colon and rectum and its relationship
to surgical diseases and its treatment
33
• Describe the pathology, clinical presentation, investigations,
differential diagnosis and treatment of diseases that affect the colon
and rectum
• Enlist the common causes of lower gastro-intestinal bleeding in a
logical manner.
• Describe a management strategy for a patient suffering from lower
gastrointestinal bleeding.
• Design a management plan for a patient with inflammatory bowel
disease.
• Enumerate the types and classification of intestinal fistulas and
transcribe management options for intestinal fistulas on a given
patient.
• To be able to differentiate benign from malignant causes of lower
gastrointestinal bleeding
• Describe the management plan of patient with colorectal tumour.
• Select the appropriate site and type of stoma formation in a given
patient on the basis of surgical principles.
• ANORECTAL DISEASES (SURG-LEC-27)
• Describe the anatomy of the anus and anal canal and their relationship
to surgical disease and its treatment
• Explain the pathology, clinical presentation, investigation, differential
diagnosis and treatment of diseases that affect the anus and anal
canal
• Enlist the common perianal diseases
• Design a management plan for a patient suffering from perianal
diseases.
• Classify fistula-in-ano and devise a management plan of low and high
anal fistula
• Describe the conservative management and enumerate surgical
options for Anal Fissure
• Classify Perianal Abscess and device management plan for such
patients
• Recommend a comprehensive management plan for the patient of
Haemorrhoids including surgical procedures.
• Enlist complications following perianal surgery
• ABDOMINAL WALL HERNIAS (SURG-LEC-28):
• Summarize the basic anatomy of abdominal wall and its natural or
acquired weaknesses.
• Enlist the causes of abdominal hernia from the commonest to rarest
34
• Classify the various types of abdominal wall hernia as per accepted
guidelines.
• Explain the complications of abdominal hernias as per natural
progression of the disease.
• Tabulate the difference between obstructed and strangulated hernia.
• List the baseline investigations needed for pre-operative workup of a
hernia patient.
• Prioritize the problem specific investigations needed for pre-operative
workup for hernia patient.
• Recommend a comprehensive management plan for the given patient
of inguinal hernia including surgical procedures.
• Correlate the reasons for complications following hernia surgery.
• GENITOURINARY DISEASES (URO-LEC-1,2)
• Recognise the important congenital abnormalities of the genitourinary
tract
• Describe the aetiology, presentation and management of common
genitourinary diseases
• Summarize the pathophysiology of renal stone formation
• Classify renal stones
• Recommend the management plan of sepsis in the upper urinary tract
• Propose a management plan based on surgical principles for
management of a patient with renal calculi.
• Enumerate the causes of haematuria.
• Formulate a working plan for management of a patient with renal
tumour.
• Outline a management plan for a patient suffering from urinary
bladder outlet obstruction.
• VASCULAR DISEASES AND VARICOSE VEINS (SURG-LEC-29)
• To summarize venous anatomy and the physiology of venous return
• Explain the pathophysiology of vascular diseases
• Enlist the causes of varicose vein, deep venous thrombosis, vascular
insufficiency and their management.
• Interpret the clinical findings to achieve a working diagnosis in a
patient presenting with a lower leg ulcer and manage such a patient.
• Summarize a management approach for a patient diagnosed as having
peripheral vascular disease.
• Construct a plan for management of a patient diagnosed as having
diabetic foot
• SCROTAL SWELLINGS (URO-LEC-3)
• Summarize the basic anatomy of testis and testicular descent.
35
• Enlist the causes of scrotal swellings from the commonest to rarest
• Classify the various types of scrotal swellings.
• Tabulate the difference between varicocele, hydrocele and epididymal
cyst
• Differentiate between testicular torsion and epididymo-orchitis
• Explain Testicular torsion as a urological emergency
• List the baseline investigations needed for pre-operative workup of a
patient with scrotal swelling
• Recommend a comprehensive management plan for the given patient
with scrotal swelling including the management of the common scrotal
swellings (varicocele, hydrocele and epididymal cysts)
• Order and interpret appropriate investigations including tumour
markers in a patient with testicular tumour.
• Enlist investigations needed to stage accurately a patient with
testicular tumour.
• Outline a management plan for a testicular tumour.
• Formulate a plan for managing a case of undescended testis.
36
LEARNING OBJECTIVES: CASE BASED DISCUSSION
• ABDOMINAL WALL HERNIAS (CBD-1)
• Justify the correct steps of recording a history from a given patient.
• Demonstrate the logical steps of examining a patient with hernia
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis
• Summarize the basic anatomy of abdominal wall and its natural or
acquired weaknesses.
• Enlist the causes of abdominal hernia from the commonest to rarest
• Classify the various types of abdominal wall hernia as per accepted
guidelines
• Explain the complications of abdominal hernias as per natural
progression of the disease.
• Demonstrate with complete accuracy the difference between an
inguino-scrotal and scrotal swelling.
• Demonstrate the difference between a femoral, indirect and direct
inguinal hernia during physical examination.
• Show with complete precision the differences between a reducible and
irreducible inguinal hernia during physical examination
• Tabulate the difference between obstructed and strangulated hernia.
• Defend the working diagnosis of an abdominal wall hernia after taking
a history and physical examination of a given patient.
• List the baseline investigations needed for pre-operative workup of a
hernia patient.
• Recommend a comprehensive management plan for the given patient
of inguinal hernia including surgical procedures.
• Correlate the reasons for complications following hernia surgery
• Informed Consent for hernioplasty (Faculty with PGT or house
offices as simulated patient) Practice session as well
At the end of the 40 minutes encounter the final year student will be able
to:
• Enlist the complete protocols for obtaining an informed consent from
a patient of hernia.
• Enumerate the possible complications associated with hernioplasty.
• Discuss the anaesthetic options that may be employed during the
surgical procedure.
37
• Employ accepted guidelines for attaining an informed consent from a
simulated patient of hernia who is to undergo elective surgery.
Gall bladder diseases (cbd-2)
• Elicit a focused history from a patient suffering from acute /chronic
cholecystitis
• To differentiate accurately between biliary colic and acute cholecystitis
• Record a pertinent history from the given patient to reach a working
diagnosis.
• Justify the correct steps of recording a history from a given patient.
CASE BASED
• To summarize the basic anatomy and physiology of the gall bladder
and bile ducts.
• To demonstrate the pathophysiology, management and complications
of gallstones
• Enlist the disorders of the biliary tree
• Classify malignant disease of the gall bladder and bile ducts
• Enlist the causes of right hypochondrial pain from the commonest to
rarest
• Classify the various types of gall stones and their causes.
• Explain the possible complications of gall stones.
• Demonstrate murphy’s sign on clinical examination.
• Demonstrate the difference between biliary colic, acute and chronic
cholecystitis during physical examination.
• Perform a focused examination in a patient with right hypochondrial
pain
• Enumerate differential diagnosis of right hypochondriac pain
• Diagnose a patient suffering from gall bladder diseases on the basis
of a focused history and examination.
• Plan and justify required investigations including invasive
investigations in gall bladder diseases.
• Outline a management plan for a patient most likely suffering from
gall bladder diseases presenting to the emergency ward / OPD.
• Describe a management plan including surgical options for a patient
suffering from cholelithiasis and its complications.
• To understand the basic concept of minimal invasive surgery including
laparoscopic cholecystectomy.
• Enlist the advantages, limitations and possible complications of laparoscopic surgery.
Informed Consent for cholecystectomy (Faculty with PGT or house
officers as simulated patient) Practice session as well
38
At the end of the 40 minutes encounter the final year student will be able to:
• Enlist the complete protocols for obtaining an informed consent from
a patient of cholelithiasis. • Counsel A Patient with Acute cholecystitis and its complication for
any required intervention. • Obtain an informed consent from a patient or his/her family member
for laparoscopic cholecystectomy and possible conversion to an open procedure with reasoning.
• Enumerate the advantages, limitations and possible complications of laparoscopic surgery.
• Discuss the anaesthetic options that may be employed during the surgical procedure.
• Employ accepted guidelines for attaining an informed consent from a simulated patient of cholelithiasis who is to undergo elective surgery.
ACUTE APPENDICITIS (CBD-3)
• Elicit a focused history from a patient suffering from acute appendicitis
so as to reach a working diagnosis.
• Perform a focused examination in a patient with right lower quadrant
pain.
• To exclude other differential diagnosis of acute appendicitis
• Record a pertinent history from the given patient to reach a working
diagnosis.
• Justify the correct steps of recording a history from a given patient.
CASE BASED
• To summarize the aetiology and surgical anatomy of acute
appendicitis
• Explain the basic concept of migratory right iliac fossa pain.
• Enlist the causes of right iliac fossa pain from the commonest to rarest
• To demonstrate the clinical signs of acute appendicitis
• Enlist the investigation needed for suspected appendicitis
• Outline a management plan for a patient suffering from acute
appendicitis.
• Explain basic surgical techniques of appendectomy
• Enumerate common conditions encountered preoperatively
• Describe the management of postoperative problems
•
ACUTE PANCREATITIS (CBD-4)
• Record a pertinent history from a patient most likely suffering from
acute pancreatitis
• Perform a focused examination in a patient with upper abdominal pain.
• To exclude other differential diagnosis of acute pancreatitis
39
• Record a pertinent history from the given patient to reach a working
diagnosis.
Informed Consent for appendicectomy (Faculty with PGT or house officers as simulated patient) Practice session as well
At the end of the 40 minutes encounter the final year student will be able to:
• Enlist the complete protocols for obtaining an informed consent from a patient of appendicitis
• Counsel a patient with acute appendicitis and its complication for any required intervention.
• Obtain an informed consent from a patient or his/her family member for appendicectomy
• Discuss the anaesthetic options that may be employed during the
surgical procedure. • Employ accepted guidelines for attaining an informed consent from a
simulated patient of appendicitis who is to undergo surgery.
CASE BASED
• Summarize the surgical anatomy and physiology of pancreas.
• Enlist congenital abnormalities of the pancreas
• Enumerate the causes of acute pancreatitis.
• Enlist the differential diagnosis of acute pancreatitis
• Demonstrate various scoring systems of assessment of pancreatitis
• Enlist the investigation needed for suspected pancreatitis
• Develop a management plan for a patient suffering from acute
pancreatitis.
• Counsel a patient suffering from acute pancreatitis about the
management plan and justify the utilization of surgical options if
needed to be proceeded on.
OBSTRUCTIVE JAUNDICE (CBD-5) • Take a focused history from a patient suffering from obstructive
jaundice to reach a rational cause for the same.
• To differentiate accurately between benign and malignant causes of
obstructive jaundice
• To demonstrate Courvoisier’s law.
• Justify the correct steps of recording a history from a given patient.
CASE BASED
• To summarize the basic anatomy and physiology of the biliary system.
• To demonstrate the pathophysiology and complications of obstructive
jaundice
• Enlist the common causes of obstructive jaundice in a sequential
manner.
• Classify the various types of jaundice and their causes.
40
• Perform a focused examination in a patient with obstructive jaundice
• Diagnose a patient suffering from obstructive jaundice on the basis of
a focused history and examination.
• Plan and justify required investigations including invasive
investigations in obstructive jaundice
• Outline a management plan for a patient suffering from obstructive
jaundice presenting to the emergency ward / OPD.
• Describe a management plan including surgical options for a patient
suffering from obstructive jaundice and its complications.
SCROTAL SWELLINGS (CBD-6) • Justify the correct steps of recording a history from a given patient.
• Demonstrate the logical steps of examining a patient with a scrotal
swelling
• To differentiate accurately between scrotal and inguino-scrotal
swellings
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis.
CASE BASED
• Summarize the basic anatomy of testis and testicular descent.
• Enlist the causes of scrotal swellings from the commonest to rarest
• Classify the various types of scrotal swellings
• Demonstrate with complete accuracy the difference between an
inguino-scrotal and scrotal swelling.
• Tabulate the difference between varicocele, hydrocele and epididymal
cyst
• To differentiate between testicular torsion and epididymo-orchitis
• Demonstrate testicular maldescent and to appreciate the reasons for
intervention
• Explain testicular torsion as a urological emergency
• Differentiate testicular tumours from other scrotal swelling on the
basis of clinical history and examination
• List the baseline investigations needed for pre-operative workup of a
patient with scrotal swelling
• Recommend a comprehensive management plan for the given patient
with scrotal swelling including the management of the common scrotal
swellings (varicocele, hydrocele and epididymal cysts)
• Order and interpret appropriate investigations including tumour
markers in a patient with testicular tumour.
41
• Enlist investigations needed to stage accurately a patient with
testicular tumour.
• Outline a management plan for a testicular tumour.
• Formulate a plan for managing a case of undescended testis.
• Informed consent for testicular surgery (Faculty with PGT or
house offices as simulated patient) Practice session as well
• At the end of the 40 minutes encounter the final year student will be
able to:
• Enlist the complete protocol for obtaining an informed consent from a
patient of scrotal swelling
• Counsel an adult patient who is to undergo surgery for an
undescended testis including orchidectomy
• Enumerate the possible complications associated with surgery
• Discuss the anaesthetic options that may be employed during the
surgical procedure.
• Counsel a patient of testicular tumour regarding orchidectomy and
possible adjuvant treatment
•
BREAST LUMP & ASSOCIATED DISEASES (CBD-6) • Elicit a focused history from a patient having breast lump
• To differentiate accurately between benign and malignant breast lump
• Evaluate risk factors for malignant breast diseases.
• Record a pertinent history from the given patient to reach a working
diagnosis.
CASE BASED
• To summarize the basic anatomy and physiology of the breast.
• To demonstrate congenital anomalies of breast
• Enlist the causes of breast lump
• Classify breast lump and association with hormonal changes
• Demonstrate the difference between benign and malignant breast
lump on physical examination.
• Justify the diagnosis on the basis of history and physical examination
of a patient presenting with a breast lump.
• Demonstrate triple assessment
• Plan and justify required investigations for breast lump.
• Enlist investigations needed for staging breast carcinoma
• Propose a management plan for a patient who has been diagnosed as
a benign breast disease.
• Devise a management strategy on the basis of current scientific
evidence for a patient diagnosed as having a malignant breast disease.
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Informed consent for modified radical mastectomy (Faculty
with PGT or house officers as simulated patient) Practice
session as well
• At the end of the 40 minutes encounter the final year student will be
able to:
• Enlist the complete protocols for obtaining an informed consent from
a patient of breast lump
• Obtain an informed consent from a patient who is to undergo a
modified radical mastectomy explaining all common possible
outcomes.
• Counsel a patient diagnosed as having malignant breast disease about
the future management with the possible options of chemotherapy,
hormone therapy and radiotherapy.
• Counsel the patient regarding neoadjuvant chemoradiotherapy
• Explain possible post-operative complications after mastectomy.
• Explain various breast reconstructive procedures available after
mastectomy.
VASCULAR DISEASES AND VARICOSE VEINS (CBD-7)
• Elicit a focused history from a patient having vascular disorder
• Evaluate risk factors for vascular diseases.
• Record a pertinent history from the given patient to reach a working
diagnosis.
• Justify the correct steps of recording a history from a given patient.
CASE BASED
• To summarize venous anatomy and the physiology of venous return
• Explain the pathophysiology of vascular diseases
• Enlist the causes of varicose vein, deep venous thrombosis, vascular
insufficiency and venous ulceration.
• Justify the diagnosis on the basis of history and physical examination
of a patient presenting with a vascular disorder.
• Able to examine and perform various specified test for the clinical
diagnosis of varicose veins
• Interpret the clinical findings to achieve a working diagnosis in a
patient presenting with a lower leg ulcer and manage such a patient.
• Summarize a management approach for a patient diagnosed as having
peripheral vascular disease.
• Construct a plan for management of a patient diagnosed as having
diabetic foot
Informed consent for varicose vein surgery (Faculty with PGT or
house officers as simulated patient) Practice session as well
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• At the end of the 40 minutes encounter the final year student will be
able to:
• Enlist the complete protocols for obtaining an informed consent from
a patient of varicose veins
• Obtain an informed consent from a patient who is to undergo surgery
for varicose veins.
• Explain possible post-operative complications after vascular surgery
• Explain various radiological procedures available for treatment of
varicose veins
DYSPHAGIA (CBD-8)
• Elicit a focused history from a patient having dysphagia
• Evaluate risk factors for carcinoma oesophagus
• Record a pertinent history from the given patient to reach a working
diagnosis.
CASE BASED
• To summarize the basic anatomy and physiology of the oesophagus
and their relationship to disease
• To enumerate congenital anomalies of oesophagus
• Enlist the causes of dysphagia
• Classify dysphagia
• To enlist the clinical features, investigations and treatment of benign
and malignant diseases of oesophagus
• Plan and justify required investigations for dysphagia
• Interpret the findings on the taken history to diagnose the patient
presenting with dysphagia.
• Plan and justify required investigations for dysphagia
• Devise a plan to manage a patient with carcinoma oesophagus.
• Enumerate various types of esophagectomy according to the site of
malignant lesion.
• Formulate a nutrition support plan for a patient undergoing an
esophagectomy with emphasis on both pre and post-operative stages.
• Counsel a patient of carcinoma oesophagus about the future
management and possible outcome of the disease
INTESTINAL OBSTRUCTION (CBD-9)
• Elicit a focused history from a patient suffering from intestinal
obstruction
• To differentiate accurately between acute and chronic intestinal
obstruction
• Demonstrate the cardinal features of intestinal obstruction
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• Record a pertinent history from the given patient to reach a working
diagnosis.
CASE BASED
• To summarize the basic anatomy and physiology of small and large
intestines
• To describe the pathophysiology of intestinal obstruction
• To differentiate between dynamic and adynamic intestinal obstruction
• Enlist the causes of intestinal obstruction from the commonest to
rarest
• Classify various types of intestinal obstruction
• Demonstrate the cardinal features of intestinal obstruction on history
and examination
• Analyse the history from a patient presenting with possible intestinal
obstruction and pinpoint the most likely pathology.
• Explain the possible complications of intestinal obstruction.
• Justify a fluid and electrolyte correction regimen for a patient in
intestinal obstruction.
• Outline a strategy to manage a patient with intestinal obstruction.
• Conclude indications for surgery and other treatment options in bowel
obstruction
• Propose a nutrition plan which includes both enteral and parental
components for a patient who has undergone small bowel resection.
Informed consent for laparotomy (Faculty with PGT or house
officers as simulated patient) Practice session as well
At the end of the 40 minutes encounter the final year student will be able
to:
• Enlist the complete protocols for obtaining an informed consent from
a patient of intestinal obstruction
• Obtain an informed consent from a patient or his/her family member
for laparotomy for intestinal obstruction
• Counsel the patient regarding stoma formation and care of stoma.
• Employ accepted guidelines for attaining an informed consent from a
simulated patient of intestinal obstruction who is to undergo surgery.
COLORECTAL DISEASES (CBD-10)
• Justify the correct steps of recording a history from a given patient of
lower gastrointestinal bleeding.
• Demonstrate the logical steps of examining a patient with lower
gastrointestinal bleeding.
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis.
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• Analyse a history from a patient and be able interpret the findings to
identify the specific cause for the lower gastro-intestinal bleeding.
CASE BASED
• Summarize the anatomy of the colon and rectum and its relationship
to surgical diseases and its treatment
• Describe pathology, clinical presentation, investigation, differential
diagnosis and treatment of diseases that affect the colon and rectum
• Enlist the common causes of lower gastro-intestinal bleeding in a
logical manner.
• Analyse a history from a patient and be able interpret the findings to
identify the specific cause for the lower gastro-intestinal bleeding.
• Describe a management strategy for a patient suffering from lower
gastrointestinal bleeding.
• Diagnose a patient with inflammatory bowel disease (ulcerative colitis
and Crohn’s) on the basis of history and examination.
• Order and interpret appropriate investigations in a patient with
inflammatory bowel disease.
• Design a management plan for a patient with inflammatory bowel
disease.
• Enumerate the types and classification of intestinal fistulas and
transcribe management options for intestinal fistulas on a given
patient.
• To be able to differentiate benign from malignant causes of lower
gastrointestinal bleeding
• Identify patient of suspected colorectal tumour on the basis of history
and clinical examination.
• List the baseline investigations needed for pre-operative workup of a
patient with colorectal tumour
• Describe the management plan of patient with colorectal tumour
• Select the appropriate site and type of stoma formation in a given
patient on the basis of surgical principles.
• Identify the complications of stoma.
Informed consent for colorectal Surgery (Faculty with PGT or house
offices as simulated patient) Practice session as well
At the end of the 40 minutes encounter the final year student will be
able to:
• Enlist the complete protocols for obtaining an informed consent from
a patient of colorectal tumor.
• Enumerate the possible complications associated with surgery.
• Discuss the anaesthetic options that may be employed during the
surgical procedure.
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• Counsel a given patient regarding permanent stoma formation
following abdominoperineal resection for carcinoma rectum.
• Employ accepted guidelines for attaining an informed consent from a
simulated patient of colorectal carcinoma who is to undergo elective
surgery.
NECK SWELLINGS (CBD-11)
• Justify the correct steps of recording a history from a given patient.
• Demonstrate the logical steps of examining a patient with neck
swelling
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis.
CASE BASED
• To describe the development and anatomy of the thyroid and
parathyroid glands
• To summarize the physiology and investigation of thyroid and
parathyroid disorders
• Explain the lymphatic drainage of neck
• Enlist the causes of neck swelling from the commonest to rarest
• Classify various types of neck swelling
• Justify the most likely cause of the neck swelling on the basis of history
and physical examination in a given patient.
• To be able to select appropriate investigations for neck swellings
• Devise a management plan including medical, surgical and nuclear
medicine options for a patient with goitre.
• To describe how to treat thyrotoxicosis and thyroid failure
• To justify when to operate on a thyroid swelling
• To describe different types of thyroid surgeries
• To describe the investigation and management of
hyperparathyroidism
• To recognize the risks and complications of thyroid and parathyroid
surgery
Informed consent for thyroid Surgery (Faculty with PGT or house
offices as simulated patient) Practice session as well
At the end of the 40 minutes encounter the final year student will be
able to:
• Enlist the complete protocols for obtaining an informed consent from
a patient of thyroid swelling
• Enumerate the possible complications associated with surgery.
• Discuss the anaesthetic options that may be employed during the
surgical procedure.
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• Obtain an informed consent from a patient who is to undergo total
thyroidectomy for a hyperthyroid goitre at present in a euthyroid
state.
• Employ accepted guidelines for attaining an informed consent from a
simulated patient of thyroid swelling who is to undergo elective
surgery.
• GASTRIC CANCER & GASTRIC OUTLET OBSTRUCTION (CBD-12)
• Justify the correct steps of recording a history from a given patient.
• Demonstrate the logical steps of examining a patient with a possible
gastric outlet obstruction
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis.
CASE BASED
• To summarize the gross and microscopic anatomy and
pathophysiology of the stomach in relation to the disease
• Enlist the causes of gastric outlet obstruction.
• To be able to decide on the most appropriate techniques to use in the
investigation of patients with gastric outlet obstruction
• To describe the critical importance of gastritis and helicobacter pylori
in upper gastrointestinal disease
• To be able to investigate and treat peptic ulcer disease and its
complications
• To be able to recognise the presentation of gastric cancer and
understand the principals involved in its treatment
• Interpret the clinical findings to achieve a working diagnosis in a
patient presenting with gastric outlet obstruction.
• Summarize a management approach for a patient diagnosed as gastric
carcinoma.
GENITOURINARY DISEASES (CBD-13)
• Justify the correct steps of recording a history from a given patient.
• Demonstrate the logical steps of examining a patient with a possible
genitourinary disease
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis.
CASE BASED
• To recognise the important congenital abnormalities of the
genitourinary tract
• The describe the aetiology, presentation and management of common
genitourinary diseases
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• Summarize the pathophysiology of renal stone formation
• Classify renal stones
• Recommend the management plan of sepsis in the upper urinary tract
• Diagnose a patient suffering from renal calculi on the basis of history
and physical examination.
• Propose a management plan based on surgical principles for
management of a patient with renal calculi.
• Enumerate the causes of haematuria.
• Devise a working plan to accurately identify specific cause of
haematuria in given patient.
• Formulate a working plan for management of a patient with renal
tumour.
• Interpret the findings on the basis of history and examination in a
patient suffering from renal tumour.
• Elicit a pertinent history so as to be able to reach a diagnosis from a
patient suffering from benign prostatic hypertrophy.
• Outline a management plan for a patient suffering from urinary bladder outlet obstruction.
Informed consent for TURP (Faculty with PGT or house offices as
simulated patient) Practice session as well At the end of the 40 minutes encounter the final year student will be able
to: • Enlist the complete protocols for obtaining an informed consent from
a patient of benign prostatic hyperplasia • Enumerate the possible complications associated with TURP
• Discuss the anaesthetic options that may be employed during the surgical procedure.
• Employ accepted guidelines for attaining an informed consent from a simulated patient of benign prostatic hyperplasia who is to undergo TURP.
PERIANAL DISEASES (CBD-13)
• Justify the correct steps of recording a history from a given patient.
• Demonstrate the logical steps of examining a patient with perianal
disease.
• Record a pertinent history from the given patient so as to be able to
reach a working diagnosis.
CASE BASED
• To describe the anatomy of the anus and anal canal and their
relationship to surgical disease and its treatment
• Explain the pathology, clinical presentation, investigation, differential
diagnosis and treatment of diseases that affect the anus and anal
canal
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Informed consent for perianal surgery (faculty with PG or house offices
as simulated patient) practice session as well
At the end of the 40 minutes encounter the final year student will be
able to:
• Enlist the complete protocols for obtaining an informed consent from a
patient undergoing perianal surgery.
• Enumerate the possible complications associated with surgery.
• Discuss the anaesthetic options that may be employed during the surgical
procedure.
• Employ accepted guidelines for attaining an informed consent from a
simulated patient of perianal disease who is to undergo perianal surgery.
Teaching Schedule for MBBS Students:
Third year MBBS:
• Enlist the common perianal diseases
• Diagnose on the basis of history and examination a patient presenting
with common perianal problem
• Design a management plan for a patient suffering from perianal
diseases.
• Classify fistula-in-ano and devise a management plan of low and high
anal fistula
• Describe the conservative management and enumerate surgical
options for anal fissure
• Classify perianal abscess and device management plan for such
patients
• Recommend a comprehensive management plan for the given patient
of haemorrhoids including surgical procedures.
• Correlate the reasons for complications following perianal surgery.
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Duration of clinical posting
Timing of clinical posting
Objective
Clinical postings
Time table
Assessment
9 weeks
2.5 Hours/day
Carry out a focused history & do Physical
examination
Outpatient’s clinics, theatre, surgical day ward,
ward rounds and emergency room.
Monday OT
Tuesday OPD/ER
Wednesday Bed side teaching
Thursday OPD/ER
Friday Bed side teaching
Attendance 25%
Log book 25%
History and examination 25%
Viva 25%
Fourth Year MBBS:
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Duration of clinical posting
Timing of clinical posting
Objective of
Clinical Postings
Time Table
Assessment
9 weeks
2.5 hours/day Clinical posting
2 hours on Mondays and Tuesdays Tutorial
Carry out a focused history, do physical examination,
differential
diagnoses, justify the diagnosis
Outpatient’s clinics, theatre, surgical day ward, ward rounds,
and emergency room.
For clinical attachments
Monday OPD/ER
Tuesday OT
Wednesday Bedside teaching
Thursday OT
Friday OPD/ER
For Tutorials
Monday Orthopedics
Tuesday Case presentations
Attendance 25%
Log book 25%
History and examination 25%
Viva 25%
FINAL YEAR MBBS
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EXPECTATION FROM THE STUDENTS:
Duration of clinical
posting
Timing of clinical
posting
Objective
Clinical postings
Time Table
Assessment
9 weeks
2.5 hours/day
2 hours/day Tutorial
Carry out a focused history, do physical examination, differential
diagnoses, justify the diagnosis formulating the plan of management
and follow-up.
Outpatient’s clinics, theatre, surgical day ward, ward rounds, case
conferences and interdisciplinary meetings.
For Clinical Attachments
Monday OPD/ER
Tuesday OT
Wednesday Bed Side Teaching
Thursday OT
Friday OPD/ER
For Tutorials
Monday Emergency Cases discussions
Tuesday Case Presentations
Wednesday Self Learning
Thursday Core Study
Friday Interdisciplinary/M&M Meetings.
Attendance 25%
Log Book 25%
OSCE 50%
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Expected clinical competencies
By the end of surgery course; students would be able to:
1. Carry out a focused history, do physical examination, justify the
diagnosis, discuss management plans, and perform relevant follow-up
of the progress of the following clinical conditions (at least one patient
for each clinical condition)
• Wounds and ulcers
• Swellings
• Common infections (e.g. Hand infections, face infections,
erysipelas)
• Anal disorders – hernias – breast masses – jaundice - acute
abdomen
• Inguino-scrotal swellings
• Common neck swellings (thyroid, lymph nodes)
• Varicose veins
• Foot problems in diabetics
• Dyspepsia
2. Provide 1st aid measures for acute abdomen.
3. Identify common surgical instruments and describe their use.
4. Prepare patients for different operative intervention.
5. Provide the appropriate postoperative care.
6. Identify cases that need hospital admission.
7. Write medical reports for referral and requests for investigations.
Practical or manual procedures: Refer to the manual skills which are
necessary to the student; such as venipuncture, wound stitching and
dressing. Skills labs will be held throughout the clerkships to assist the
student in learning techniques for performing a variety of skills. After
attending the mandatory sessions, students will be expected to perform
some of the skills under supervision in the clinic setting and are
encouraged to actively seek out opportunities for practice. Skill lab will
also be part of the OSCE exam. Procedure completion documented by
supervising nurse or doctor in a specific sheet provided.
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By the end of the course, the students should be able to
1. The setup and administration of oxygen therapy via a Hudson mask
2. The setup and administration of oxygen therapy via nasal prongs
3. The set up and capture of 12 lead ECG trace.
4. Attend and assist in the triage of three patients.
5. Application of a burns dressing
6. Application of a dressing to an abrasion.
7. Perform cardiopulmonary resuscitation.
8. Insert and fix urethral catheter.
9. Drain subcutaneous abscess
10. Peritoneal tapping,
11. Venous puncture, takes blood sample from vein & arteries.
12. Give intramuscular, intravenous injections and infusions.
13. Introduce nasogastric tube and endotracheal tube.
14. Observe (or assist), operations as; hernia repair, cholecystectomy,
appendectomy, laparoscopy, laparotomy, splenectomy, lymph
node biopsy and resection anastomosis.
15. Deliver one session of health education.
Interpersonal skills and responsibility
By the end of the course, the students should be able to:
1) Show responsible and compassionate behavior with the patient and his family,
considering the cultural, social and economic background, and in dealing with all
levels of education and abilities
2) Use the required communication skills for taking appropriate clinical history and
conducting clinical examination.
3) Appreciate the role of perfect understanding of basic sciences (anatomy,
physiology, pathology, etc.) and the pathophysiological process relevant to
surgical practice.
4) Be acquainted with the epidemiological profile of the population and society,
their heritage, cultural, social, geographic and economic characteristics, and
relationship of all these to etiology and management of surgical diseases.
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5) Have the knowledge and skills necessary to identify the health problems of a
patient in emergency situations, common endemic or epidemic diseases and
disabilities, including health promotion, disease prevention, treatment,
rehabilitation and follow up.
6) Wise selection of the most appropriate and cost effective investigations to reach
the proper diagnosis, considering the patient rights and abilities, and the
available health system resources, weighing the pros and cons of surgical
intervention.
7) Interact effectively with the surgical and other health teams, and appreciate the
role of others
8) Be able to work within and leading a team, in clinical practice and continuous
learning in a problem based style.
Psychomotor skills to be developed
Perform surgical procedures that are basic to the expertise of all practicing
physicians. Relate each procedure to the indications, contraindications and
complications.
➢ Demonstrate the use of aseptic technique in patient care, for example,
surgical scrub, preparation of the operative site and operating room
protocol.
➢ Draw both venous and arterial blood specimens
➢ Provide wound care (dressing changes)
➢ Perform suture techniques, including placing and removing sutures and
staples
➢ Demonstrate knot tying
➢ Place an intravenous line
➢ Place a nasogastric tube
➢ Place a Foley’s catheter
➢ Observe a central venous catheter
➢ Observe thoracocentesis, paracentesis & chest tube placement
➢ Excise or biopsy small skin lesions
➢ Perform a digital rectal exam.
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➢ Local anesthetic infiltration
➢ Blood culture from peripheral and central sites
➢ Subcutaneous, intra-dermal, intramuscular and intravenous injection
➢ Intravenous medication
➢ Intravenous infusions including perfusion of fluid, blood and blood
products
➢ Airway care
➢ Complete a laboratory / histopathology form for a relevant disease.
Communication skills: These are general skills which should be consciously and
relentlessly developed in the medical graduate in order to improve their
professional performance. It is clearly vital attribute for any doctor. The department
of surgery encourages and teaches communication skills and supports and
subscribes to initiatives to improve communication skills in medical students and
indeed as interns in their pre-registration year.
Each student is expected to use this logbook, on a daily basis, for recording his
clinical experience during the course. Each activity should be evaluated and
endorsed by the attending supervisor. Submitting the completed logbook will be
one of the requirements for passing the course. This logbook will serve as a guide
to medical schools to implement structured training programs in the surgery clinical
courses, and to establish the managerial and administrative support for carrying out
those programs. It is noteworthy that this first version of the manual will be
reviewed again during its actual implementation in view of the feedback of
students, faculty members, and course coordinators.
Presentation skills: These are developed throughout the course, both to small
and large groups. The clinical examination section of the final surgical
examination requires the student to present their findings formally to their
examiners, making it important for students to develop these skills.
Case report: students must submit a case report at the 5th week of clinical
posting. These reports are based on the common diseases seen by the specialty
that they are attending and will be marked and included in the progressive
assessment.
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Independent study: during the clinical years, students are strongly encouraged
to pursue an independent study project, which may consist of laboratory
research, clinical research or the application of computers in medicine. The
project is an opportunity for students to pursue an area of interest in depth, to
understand principles of scientific investigation and to work closely with a
member of the department in the pursuit of knowledge. Independent study
hours are protected times for students to prepare for core curriculum, patient
rounds, or surgical cases. Every effort is made by the clerkship staff to save hours
each week for this purpose. Students are encouraged to utilize this time for
studying.
Attitude & responsibility: -
General principles
• Medicine is a profession of service. We are routinely called upon to
subordinate our own priorities, needs, and desires to those of our patients.
This applies to student-in-training as well.
• Attending to our own needs in a healthy way will in the long run improve our
ability to be of sustained useful service to our patients.
• Patients should be protected from communicable disease.
• Required activities in all clerkships/rotations/electives in which you are
enrolled must be completed satisfactorily to pass.
• Some absences are reasonably foreseeable; others are not.
• You should make yourself available, and be willing to participate.
Attendance:
As part of Baqai University regulations, student must fulfill the minimum 75%
attendance in both lectures and clinical teaching. There will be a strict
adherence to the rules and regulation of the college regarding that. A sign in
sheet for all activities will be collected. Punctuality is expected. Absence from a
lecture is not an option!
Attendance at rounds and teaching conferences is mandatory; the clerkship
director has the prerogative to exact a grade penalty for excessive absences.
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Students will be required to see their patients before morning lectures or
rounds.
Student responsibilities:
Privacy: Morally and legally it is imperative that the right of the patient is
respected at all times. It is mandatory that information acquired regarding a
patient not be communicated to a third party except in the course of clinical
management of the patient. Particular sensitivity must be given to some medical
examinations, e.g breast, vaginal and rectal examinations. These must only be
done with the express verbal consent of the patient by managing doctor.
Misrepresentation: A student should accurately represent himself to patients
and others on the health care team. Students should never introduce themselves
as “doctor” as this is clearly a misrepresentation of the student’s position,
knowledge and authority.
Criticism of colleagues: it is unethical and harmful for a student to disparage,
without good evidence, the professional competence, knowledge, qualifications
or services of a colleague to staff, students, acquaintances or a patient. It is also
unethical to imply by word, gesture, or deed that a patient has been poorly
managed or mistreated by a colleague without tangible evidence. Professional
relations among all members of the medical community should be marked with
civility. Thus, scholarly contributions should be acknowledged, slanderous
comments and acts should be avoided and each person should recognize and
facilitate the contributions of others to the community. The medical student will
deal with professional staff and peer members of the health team in a
cooperative and considerate manner.
Professionalism:
• Demonstrate a commitment to excellence in carrying out professional
responsibilities.
• Act with altruism, honor and integrity in professional life.
• Respect patients’ rights and wishes.
• Act in a respectful manner toward patients, faculty, colleagues and staff.
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• Model good leadership in interactions with others, and foster the development
of others.
• When appropriate, delineate how personal behaviors impact student
colleagues, faculty, patients, and other members of the health care team.
• Demonstrate consideration for patient’s comfort and concern for feelings and
privacy during interviews and examinations.
• Demonstrate reliability, dependability, integrity and courtesy in all learning
settings.
• Demonstrate emotional maturity and appropriately resolve tensions and
conflicts.
• Recognize and describe own role and the roles of other members of the team.
Dress code: By design, the surgical clerkship requires extensive contact with
patients during various phases of diagnosis and treatment of surgical disease. The
students in the department of surgery represent the department as well as the
attending physicians in the various institutions in which they work. Some guidelines
have been established for the appropriate dress of the surgical students. Please
don’t substitute a T-shirt or some other informal clothing for the scrub top.
Universal precautions should always be practiced if exposure to blood or body
fluids is anticipated. Remember that, all patients are assumed to have infectious
blood and bodily fluids that contain transmissible disease.
Your dress should allow for diversity of self-expression whilst respecting
patients’ and the senior medical staff’s expectation that medical students be
appropriately attired and identifiable. Patients interpret dress standards as a
reflection of professional demeanor. Inappropriate casual dress may result in
considerable anxiety amongst elderly patients as it is unprofessional. The
average age of medical patients is two generations older than that of students
and at times of stress and anxiety, such as during an illness, the expectations of
patients become increasingly important such that they override personal need
with regards to dress. So, strictly adhere to the following instruction.
1. Identity (ID) badges are visible at all times in the hospital.
2. Gentlemen be attired in proper dress with lab coat.
3. Sporting or excessively casual footwear, such as tennis shoes or casual
sandals, be avoided.
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4. Hair cut do not result in patient discomfort during examination.
5. Appropriate modesty be maintained, i.e. the avoidance of attire which
results in undue display of decolletage, midriff, body piercing or body
art.
6. Appropriate standards of grooming are maintained, i.e. gentleman to
be clean-shaven or bearded, but not unshaven or displaying “designer
stubble”.
7. If scrubs are worn outside the operating room, then they must always
be covered with a white lab coat.
Senior medical staff and tutors may be reluctant to conduct bedside tutorials if
students are inappropriately attired. As a mark of professional courtesy and
respect, students are requested to address members of the medical staff by
title, e.g. professor, doctor, mr, miss etc. Unless expressly permitted to do
otherwise.
Universal Precautions & Infection Control: Students must practice "universal
standard” (universal precautions) when dealing with patients. The actions
described as "universal standard" (universal precautions) include, but are not
limited to:
1. The use of barrier / protection methods when exposure to blood, body fluids,
or mucous membranes of patient.
2. The use of gloves for handling blood and body fluids.
3. The wearing of gloves by students acting as phlebotomists.
4 The changing of gloves between patients.
5. The use of facial shield when appropriate (during all surgery and any other
procedures where eye exposure to airborne material is possible).
6. The use of gown and apron for protection from splashing when appropriate.
7. The washing of hands between patients and if contaminated.
8. The washing of hands after removal of gloves.
9. The availability of rigid needle containers.
10. The avoidance of unnecessary handling of needles.
11. The careful processing of “sharps”
12. The avoidance of direct mouth-to-mouth resuscitation contact.
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13. The minimization of spills and splatters.
14. The decontamination of all surfaces and devices after use.
ASSESMENT METHODOLOGIES:
Final evaluation:
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The evaluation of this course depends on the students’ behavior and activity
during the course is contributed by the following:
Theory:
• Modular theory will be composed of 20 single best answers. One long
question and three short notes.
• Final theory examination will be composed of 50 single best answers. Long
question and three short notes.
OSCE:
• Modular OSCE will be composed of 15 static and interactive stations.
• 07 stations are interactive and based on history taking, clinical examination,
counseling, short cases and table viva.
• In addition, 08 non-interactive stations shall be included. These stations should
consist of clinical scenarios along with x-rays/ECG/photographs/instruments and
case based on the neurosurgery, orthopedics and trauma.
Theory:
• Pre-prof theory examination will be composed of 50 single best answers.
Two long question and four short notes.
• Final theory examination 1 will be composed of 50 single best answers.
Two long question and four short notes.
• Final theory examination 2 will be composed of 50 single best answers.
Two long question and four short notes.
OSCE:
• OSCE will be composed of 15 static and interactive stations along with 2
short cases.
DISTRIBUTION OF TOPICS
WRITTEN EXAMINATION
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PAPER I
1. Metabolic response to injury
2. Preoperative preparations
3. Post-operative management
4. Care in the operating room
5. Perioperative management in high risk patients
6. Anesthesia & pain relief
7. Fluid & electrolyte & acid base balance
8. Blood transfusion & shock
9. Thyroid / parathyroid
10. Trauma / disaster
11. Nutrition
12. Wound healing & tissue repair
13. Surgical infection
14. Principles of pediatric surgery
15. Orthopedics
16. Neurosurgery
17. Skin & subcutaneous tissue
18. Plastic surgery & burns, reconstruction of cleft lip & palate
19. Breast
20. Arterial, venous disorders & lymphatics
PAPER II
1. Thorax
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2. Esophagus
3. Stomach & Duodenum
4. Liver
5. Gall & Bladder & Bile Ducts
6. Spleen
7. Pancreas
8. Peritoneum, Omentum & Mesentery
9. Diseases of Small & Large Intestine
10. Intestinal Obstruction
11. Appendix
12. Rectum
13. Perianal Conditions Anus & Anal Canal
14. Hernia & Umbilicus & Abdominal Wall
15. Kidney & Ureter
16. Urinary Bladder, Urethra & Penis
17. Testicles & Scrotum
18. Prostate Gland
19. Transplantation & Oncology
ASSESMENT CRITERIA OF FINAL YEAR MBBS
65
THEORY 300
marks
OSCE 300
marks
Pre Prof theory paper 30 marks
MCQ
Short essay
Final theory paper 1
MCQ 75 marks
Short essay 60 marks
Final theory paper 2
MCQ 75 marks
Short essay 60 marks
300 marks
OSCE 270 marks
Internal Evaluation 30 marks
300 marks
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FEEDBACK TO THE STUDENTS
Instructions to the students:
Students are instructed to:
1- Maintain the logbook throughout the course period.
2- Make the required entries and seek evaluation and signature of the supervisor
on the same day of the event.
3- Follow the classical paradigm of the stepwise progression along the competency
scale in acquiring the manual skills: observing (1), assisting (2), doing under
supervision (3), doing independently (4).
4- Identify the required level of competence for each manual procedure, listed in
each section, by carefully reading the related statements. Those which start by
a verb that describes a real like “perform”, “do” or “insert”; should be repeatedly
practiced to reach mastery level. Statements which start by verbs like “observe”,
“witness”, or “assist” refer to procedures that the student is required to achieve
only level 1 or level 2 respectively.
5- Make use of the given feedback to improve clinical competencies, manual
procedures, and communication skills.
TEACHING METHODOLOGY AND FACILITATOR EVALUATION:
Instructions to the teachers:
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Teachers are requested to:
1- Carefully observe the performance of the student and point out the deficiencies;
if any for correction.
2- Sign the activities done or attended by the student in the same day of
performance.
3- Give constructive feedback to each student and document improvements in his
performance with repeated practice.
4- Observe their progression along the competency scale in acquiring the manual
skills: observing (1), assisting (2), doing under supervision (3), doing
independently (4).
Student Course Evaluation Questionnaire
(To be filled by each Student at the time of Course
Completion)
Department _______________________ ____ Course No _________________
Course Title__________________________Teacher Name: ___________________
Year of Study _______________________ Semester / Term _______________
Please give us your views so that Course quality can be improved. You are encouraged
to be frank and constructive in your comments
CORE QUESTIONS
Course Content and Organization Stro
ngly
Agre
e
Ag
re
e
Unce
rtain
Disa
gree
Stron
gly
Disag
ree
1. The course objectives were clear
2. The Course workload was manageable
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3. The Course was well organized (e.g. timely
access to materials, notification of changes,
etc.)
4. Comments
Student Contribution
5. Approximate level of
your own attendance
during the whole Course
<20% 21-
40%
41-60% 61-80% >81%
Strongly
Agree
Agree uncertain Disagree Strongly
Disagree
6. I participated actively in
the Course
7. I think I have made
progress in this Course
8. Comments
Learning Environment and Teaching
Methods
Stro
ngly
Agre
e
Ag
re
e
Unce
rtain
Disa
gree
Stro
ngly
Disa
gree
9. I think the Course was well structured to
achieve the learning outcomes (there was a
good balance of lectures, tutorials, practical
etc.)
10. The learning and teaching methods
encouraged participation.
11. The overall environment in the class was
conducive to learning.
12. Classrooms were satisfactory
13. Comments
69
Learning Resources Stro
ngly
Agre
e
Ag
re
e
Uncer
tain
Disa
gree
Stro
ngly
Disa
gree
14. Learning materials (Lesson Plans, Course
Notes etc.) were relevant and useful.
15. Recommended reading Books etc. were
relevant and appropriate
16. The provision of learning resources in the
library was adequate and appropriate
17. The provision of learning resources on the
Web was adequate and appropriate ( if
relevant)
18 Comments
Quality of Delivery Stro
ngly
Agre
e
Ag
ree
Uncer
tain
Disa
gree
Stro
ngly
Disa
gree
19. The Course stimulated my interest and
thought on the subject area
20. The pace of the Course was appropriate
21. Ideas and concepts were presented clearly
22.Comments
Assessment Stro
ngly
Ag
ree
Uncer
tain
Disa
gree
Stro
ngly
70
Agre
e
Disa
gree
23. The method of assessment were
reasonable
24. Feedback on assessment was timely
25. Feedback on assessment was helpful
26. Comments
Additional Core Questions
Instructor / Teaching Assistant Evaluation Stro
ngly
Agre
e
Ag
ree
Uncer
tain
Disa
gree
Stro
ngly
Disa
gree
27. I understood the lectures
28. The material was well organized and
presented
29. The instructor was responsive to student
needs and problems
30. Had the instructor been regular
throughout the course?
Tutorial Stro
ngly
Agre
e
Ag
ree
Uncer
tain
Disa
gree
Stro
ngly
Disa
gree
30. The material in the tutorials was useful
31. I was happy with the amount of work
needed for tutorials
32. The tutor dealt effectively with my
problems
Practical Stro
ngly
Agre
e
Ag
ree
Uncer
tain
Disa
gree
Stro
ngly
Disa
gree
71
33. The material in the practical was useful
34. The demonstrators dealt effectively with
my problems.
Overall Evaluation
35.The best features of the Course were:
36.The Course could have been improved by:
Equal Opportunities Monitoring (Optional)
37. The University does not tolerate discrimination on any irrelevant
distinction (e.g. race, age, gender) and is committed to work with diversity
in a wholly positive way. Please indicate below anything in relation to this
Course which may run counter to this objective:
Demographic Information: (Optional)
38. Full/part time study: Full Time Part Time
39.Do you consider yourself to be disabled: Yes No
40. Domicile:
41.Gender: Male Female
❖ 42. Age Group: less than 22 22-29 over 29
43. Campus: Distance Learning/ Collaborative
72
Teacher Evaluation Form
(To be filled by the student)
Course Title and Number: ____________________________________________
Name of Instructor: ________________________Semester___________________
Department: _____________________________Degree_______________________
Use the scale to answer the following questions below and make comments
A: Strongly Agree B: Agree C: Uncertain D: Disagree E: Strongly Disagree
Instructor:
The instructor is prepared for each class A B C D E
The instructor demonstrates knowledge of the subject A B C D E
The instructor has completed the whole course A B C D E
The instructor provides additional material apart from
the textbook
A B C D E
The instructor gives citations regarding current situations
with reference to Pakistani context.
A B C D E
The instructor communicates the subject matter
effectively
A B C D E
The instructor shows respect towards students and
encourages class participation
A B C D E
The instructor maintains an environment that is
conducive to learning
A B C D E
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The instructor arrives on time A B C D E
The instructor leaves on time A B C D E
The instructor is fair in examination A B C D E
The instructor returns the graded scripts etc. in a
reasonable amount of time
A B C D E
The instructor was available during specified office hours A B C D E
Course:
The Subject matter presented in the course has increased
your knowledge of the subject
A B C D E
The syllabus clearly states course objectives
requirements, procedures and grading criteria
A B C D E
The course integrates theoretical course concepts with
real-world applications
A B C D E
The assignments and exams covered the materials
presented in the course
A B C D E
The course material is modern and updated A B C D E
Comments about:
Instructor:_____________________________________________________________
__________________________
Course:_______________________________________________________________
__________________________
Informal Internal Assessment by the Faculty
There will be no formal allocation of marks for the component of Internal Assessment
so that students are willing to confront their weaknesses rather than hiding them from
their instructors.
74
READING MATERIALS
Independent Reading:
The suggested textbooks for the surgical clerkships are
• Bailey & Love's Short Practice of Surgery, 27th Edition
• Browse's Introduction to the Symptoms and Signs of Surgical Disease (6th
Edition)
• Current Diagnosis & Treatment Surgery, 15th Edition by Gerard M. Doherty
• Essentials of General Surgery, 5th Edition by Peter F. Lawrence.
• NMS surgery casebook by Bruce E. Jarrell
• Surgery: Pre Test self-assessment and review by Norman J Snow
• Surgical Recall by Lorne Blackbourne.
It is advised that students should extensively read textbooks for preparation of
examination. It is expected that the student will spend approximately 8-12 hours per
week reading independently.
Websites for Surgery Clerkship
1. www.emedicine.com/ GENERAL-SURGERY.HTM
2. www.priamlpictures.com/index.aspx
3. www.websurg.com
4. www.nim.nih.gov.research/visible/visible-human.html
5. www.ncbi.nim.nih.gov/books/bv.fcgi
6. www.vesalius.com
7. www.aamc.org/mededportal
Website to Access Videos and Presentations:
8. www.upstate.edu/courseware/video/
American College of Surgeons Website for Access to Modules (Knot Tying,
Suturing, Chest Tubes, Etc.
9. www.elearning.facs.org
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